Florida Medicaid is a health insurance program funded by federal and state dollars, providing medical and health-related services to low-income individuals, including children, pregnant women, parents, seniors, and disabled individuals.
This guide outlines the 2025 eligibility criteria, income limits, asset rules, and application process for Florida Medicaid, based on federal and Florida Agency for Health Care Administration (AHCA) guidelines, with a focus on long-term care for seniors (aged 65+), as well as other eligibility groups.
Florida Medicaid Programs
Florida Medicaid offers coverage for various groups, with specific eligibility requirements based on income, assets, age, and medical needs. The main programs include:
- Institutional / Nursing Home Medicaid: An entitlement program covering nursing home care, hospitals, and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). Requires a Nursing Facility Level of Care (NFLOC).
- Home and Community Based Services (HCBS) Waivers: Non-entitlement programs with limited slots, offering services like in-home care, adult day care, and delivered meals to help seniors and disabled individuals avoid institutionalization. Programs like the Long-Term Care (LTC) Waiver may have waiting lists.
- Regular Medicaid (Aged, Blind, and Disabled): Covers low-income elderly, blind, or disabled individuals, with less stringent medical requirements than long-term care programs.
- Medicaid for Children and Pregnant Women: Covers children up to age 19 and pregnant women with higher income limits through Florida KidCare.
- Medicaid for Parents and Caretaker Relatives: Covers low-income parents or caretakers of dependent children.
Florida has not expanded Medicaid under the Affordable Care Act (ACA), resulting in stricter eligibility rules, leaving many low-income adults without children in a coverage gap.
Eligibility for Florida Medicaid
Eligibility varies by program and population. General requirements include:
- Residency: Must be a resident of Florida.
- Citizenship: Must be a U.S. citizen, national, permanent resident, or legal alien with qualifying immigration status (e.g., refugees, asylees, or lawful permanent residents with 5+ years in the U.S.).
- Income: Varies by program, often based on a percentage of the Federal Poverty Level (FPL) or Federal Benefit Rate (FBR).
- Assets: Limits apply for long-term care and aged/blind/disabled programs.
- Medical/Functional Need: Long-term care programs require a Nursing Facility Level of Care (NFLOC), assessed through limitations in Activities of Daily Living (ADLs) or Instrumental Activities of Daily Living (IADLs).
Categorical Eligibility
Individuals receiving Supplemental Security Income (SSI) or certain means-tested benefits are often categorically eligible for Regular Medicaid, bypassing some income and asset tests.
Income Limits for Florida Medicaid
Income limits vary by program and household status. Below are the 2025 income limits for Florida, based on federal guidelines and state policies, expressed as monthly amounts unless noted.
| Eligibility Category | Single | Married (Both Applying) | Children (0–18) | Pregnant Women | Parents/Caretakers |
|---|---|---|---|---|---|
| Seniors/Disabled (Nursing Home/HCBS) | $2,901 (300% FBR) | $5,802 (300% FBR) | N/A | N/A | N/A |
| Regular Medicaid (Aged, Blind, Disabled) | $967 (100% FBR) | $1,450 (100% FBR) | N/A | N/A | N/A |
| ACA Expansion Adults (19–64) | Not Expanded | Not Expanded | N/A | N/A | N/A |
| Children/CHIP (Florida KidCare) | N/A | N/A | $2,787 (213% FPL) | N/A | N/A |
| Pregnant Women | N/A | N/A | N/A | $2,787 (213% FPL) | N/A |
| Parents/Caretakers | N/A | N/A | N/A | N/A | $281 (22% FPL) |
Additional Notes on Income Limits
- Seniors/Disabled (Nursing Home/HCBS): Income above $2,901/month must go toward care costs, except for a Personal Needs Allowance ($160/month), Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse. A Qualified Income Trust (QIT) can redirect excess income to meet eligibility.
- Married, One Spouse Applying: Applicant’s income limit is $2,901/month; non-applicant spouse’s income is not counted. The non-applicant may receive a Minimum Monthly Maintenance Needs Allowance (MMMNA) of up to $3,948/month if their housing and utility costs exceed $793.13/month (effective 7/1/25–6/30/26).
- Children/CHIP: Limits may extend to 213% FPL ($2,787/month for one) for Florida KidCare.
- Pregnant Women: Coverage extends 12 months postpartum.
- Non-Expansion State: Florida’s lack of ACA expansion means no coverage for adults aged 19–64 without dependents unless they meet other category requirements.
2025 Federal Poverty Level (FPL) Guidelines for Reference (48 States & D.C.)
| Household Size | 100% FPL | 138% FPL | 213% FPL |
|---|---|---|---|
| 1 | $15,650 ($1,304/month) | $21,597 ($1,799/month) | $33,335 ($2,787/month) |
| 2 | $21,150 ($1,762/month) | $29,187 ($2,432/month) | $45,050 ($3,754/month) |
| 3 | $26,650 ($2,221/month) | $36,777 ($3,064/month) | $56,764 ($4,730/month) |
| 4 | $32,150 ($2,679/month) | $44,367 ($3,697/month) | $68,480 ($5,707/month) |
Note: Use the FPL Calculator to estimate your household’s FPL percentage.
Asset Rules for Florida Medicaid
Asset limits apply primarily to long-term care and aged/blind/disabled programs.
Long-Term Care Medicaid (Nursing Home and HCBS Waivers)
- Single Applicant: $2,000 in countable assets (e.g., bank accounts, stocks, bonds, secondary properties).
- Married, Both Applying: $3,000 total.
- Married, One Applying: $2,000 for the applicant; $157,920 for the non-applicant spouse (Community Spouse Resource Allowance, or CSRA).
- Home Equity Limit: $730,000 for the primary residence (if applicant/spouse resides there or intends to return).
Non-Countable Assets
- Primary home (if applicant/spouse resides there or intends to return)
- One vehicle
- Household goods and personal effects
- Irrevocable Funeral Trusts (up to $15,000)
- Medicaid Compliant Annuities
- Life insurance with a face value of $2,500 or less
Medicaid’s Look-Back Rule
Florida enforces a 60-month look-back period for Nursing Home Medicaid and HCBS Waivers, reviewing asset transfers within 5 years of application. Transfers below fair market value (e.g., gifting) may result in a penalty period of ineligibility. No look-back period applies for Regular Medicaid.
Estate Recovery
Florida’s Medicaid Estate Recovery Program seeks reimbursement for long-term care costs after a beneficiary’s death, often targeting the home if not protected. Consult a Certified Medicaid Planner to safeguard assets.
Regular Medicaid (Aged, Blind, and Disabled)
- Asset Limit: $2,000 for an individual; $3,000 for a couple.
- No home equity limit or look-back period.
Medicaid for Children, Pregnant Women, and Parents
- No Asset Test: These programs focus solely on income.
Medical/Functional Requirements
For Nursing Home Medicaid and HCBS Waivers, applicants must demonstrate a Nursing Facility Level of Care (NFLOC), assessed through:
- Limitations in Activities of Daily Living (ADLs): Mobility, bathing, dressing, eating, toileting.
- Limitations in Instrumental Activities of Daily Living (IADLs): Cooking, shopping, managing finances.
- Cognitive or Behavioral Issues: E.g., Alzheimer’s or dementia, though diagnosis alone does not guarantee eligibility.
Regular Medicaid for the aged, blind, or disabled requires proof of disability or blindness per Social Security Administration criteria but not necessarily NFLOC.
Changes Due to Federal Policy
As of 2025, federal policy changes may affect Medicaid, with Florida’s non-expansion status amplifying some impacts:
- Work Requirements (Starting January 2027): Not applicable to Florida, as it has not expanded Medicaid for adults aged 19–64. Other groups (e.g., parents) may face state-specific work rules.
- Reduced Retroactive Coverage (Starting January 2027): Medicaid will cover only 2 months prior to application (down from 90 days), increasing potential medical debt for late applicants.
- More Frequent Eligibility Checks (Starting December 2026): Beneficiaries must renew eligibility every 6 months, requiring regular documentation to avoid coverage gaps.
- New Out-of-Pocket Costs (Starting October 2028): Non-exempt beneficiaries may face up to $35 per visit for specialist services or procedures, but primary care and preventive services remain free.
Options if Over the Income or Asset Limit
If your income or assets exceed the limit, consider:
- Qualified Income Trusts (QITs): Redirect excess income to meet limits for Nursing Home or HCBS Waivers. The trust is irrevocable, and Florida Medicaid must be designated as the beneficiary upon the recipient’s death.
- Irrevocable Funeral Trusts (IFTs): Pre-paid funeral and burial expenses (up to $15,000) are exempt from asset limits.
- Spend Down: Convert countable assets into exempt ones (e.g., home repairs, purchasing a vehicle, or paying off debt).
- Certified Medicaid Planners: Professionals can help with financial strategies to achieve eligibility, such as Medicaid Compliant Annuities or asset restructuring.
Application Process
To apply for Florida Medicaid:
- Online: Use the MyACCESS portal at myflorida.com/accessflorida. Check eligibility with the Medicaid Eligibility Calculator.
- Phone: Call the Florida Medicaid Customer Contact Center at 1-866-762-2237 for assistance.
- In-Person or Mail: Complete and submit an application to a local Department of Children and Families (DCF) Office. Download the application from myflorida.com/accessflorida.
- Assistance: Contact the Agency for Health Care Administration or a local Area Agency on Aging for program-related questions. Call 1-800-963-5332 for long-term care support.
Required documents include proof of income, assets, residency, citizenship, and medical records (for long-term care or disability programs). An interview may be required.
Processing Time
- Standard applications: Up to 45 days (90 days for disability-based applications).
- Expedited processing: May apply for urgent cases (e.g., pregnant women via presumptive eligibility for outpatient care).
Frequently Asked Questions
How do I apply for Medicaid in Florida?
Apply online at myflorida.com/accessflorida, by phone at 1-866-762-2237, in person at a DCF Office, or by mail with a downloaded application from myflorida.com/accessflorida.
What are the 2025 Medicaid income limits for Florida?
For seniors/disabled (Nursing Home/HCBS), the limit is $2,901/month (single) or $5,802/month (couple). Regular Medicaid (aged, blind, disabled) is $967/month (single) or $1,450/month (couple). Children and pregnant women qualify up to 213% FPL ($2,787/month for one). Parents qualify up to 22% FPL ($281/month for one).
Are there asset limits for Florida Medicaid?
Yes, for long-term care and aged/blind/disabled programs: $2,000 (single), $3,000 (couple, both applying), or $157,920 for a non-applicant spouse. No asset tests for children, pregnant women, or parents.
What is the Medicaid look-back period in Florida?
A 60-month look-back period applies to Nursing Home Medicaid and HCBS Waivers, penalizing asset transfers below fair market value. No look-back for Regular Medicaid.
Can I qualify for Medicaid if my income or assets are too high?
Yes, through Qualified Income Trusts (QITs), Irrevocable Funeral Trusts (IFTs), or spending down assets on exempt items. Consult a Certified Medicaid Planner for assistance.
Why doesn’t Florida cover low-income adults without children?
Florida has not expanded Medicaid under the ACA, so adults aged 19–64 without dependents are ineligible unless they meet other category requirements (e.g., disability).
This guide is based on 2025 federal and Florida Agency for Health Care Administration guidelines. Verify details with the Florida Medicaid program for accuracy.